Transcript Urinary System - University of Baghdad

Urinary System
Urinary System
• It is one main excretory system in the body.
• It consists of:
1.
2 kidneys which secret urine.
2. 2 ureters, which convey the urine from the kidney s to the
urinary bladder.
3. The urinary bladder where urine collects and is
temporarily stored.
4. The urethra through which the urine passes from the
urinary bladder to the exterior.
The Main Functions of the Urinary System
Most functions of the urinary system are produced by kidneys
1.
2.
Excretion: removal of waste products (including nitrogenous
compounds, urea uric acid, excess ions and some drugs) from body
fluids.
Homeostasis of water and electrolyte concentrations within the
body by:
• regulation of blood volume and pressure.
• regulation of plasma ion concentration.
• Stabilizing blood pH.
• Conserving nutrients.
3. Production of hormones: Renin, erythropoietin, thrombopoietin
4. Activate vitamin D.
kidneys
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Kidneys are bean-shaped organs, about 11 cm long, 6 cm wide, 3 cm thick and weight 150 g. in the
medial border of each kidney there is a renal helium.
located just above the waist between the peritoneum and the posterior wall of the abdomen
Because their position is posterior to the peritoneum of the abdominal cavity they are said to be
retroperitoneal organs.
The kidneys are located between the level of the last thoracic and third lumbar vertebrae
The right kidney is slightly lower than the left.
Each kidney is surrounded by a renal capsule, adipose tissue and renal fascia.
The kidneys lie on either side of the vertebral column, so each kidney is associated with a different
group of structures:
Right kidney:
superiorly – the right adrenal gland
Anteriorly – the right lobe of liver, the duodenum and the hepatic flexure of the colon.
Posteriorly – the diaphragm, and the muscles of the posterior abdominal wall.
Left Kidney:
Superior – the left adrenal gland
Anteriorly –the spleen, stomach, pancreas, jejunum and splenic flexure of the colon.
Posteriorly - the diaphragm and muscles of the posterior abdominal wall.
Internal Anatomy of the kidneys
• In longitudinal section of the kidney appears two regions:
1. Cortex (light red region)
2. Medulla (dark red brown region): there are several pyramids in
the renal medulla. The apex of each pyramids is called renal
papilla, points toward renal hilum.
• Renal papillae are surrounded by cup like structures called minor
caylces.
• Each kidney has 8-18 minor calyces which combine together to
form 2-3 major calyces.
• The major calyces combine to form in a single large cavity called
renal pelvis.
• From the renal pelvis the ureter is originated.
Blood and Nerve Supply
• The kidneys receive 20-25% of resting cardiac
out put via right and left renal arteries.
• In the adult the blood flow through the kidneys
is about 1200 ml/ min.
• Renal nerves are part of sympathetic division
of autonomic nervous system.
Blood supply of the kidneys
Microscopic structure of the kidneys
• The functional unit of the kidney is called
nephron.
• There are 1 – 2 million nephrons in each
kidney.
• The collecting ducts transport urine through
pyramids to the calyces and renal pelvis.
The Nephron
The nephron consists of:
1. renal corpuscle
(Malpighian
corpuscle)
2. renal tubule
The renal corpuscle consists of:
a). Tuft of blood capillaries called the
glomerulus.
b). A cup like, double layered
covering for the glomerulus called
the glomerular capsule (Bowman’s
capsule)
• Blood inter glomeruli through afferent arterioles and circulate through
glomerular capillaries than the blood leave glomeruli through efferent
arterioles.
• In the afferent arterioles there are specialized cells called juxtaglomerular cells
(release renin).
• Juxtaglomerular cells are part of juxtaglomerular appratus.
The renal tubule is divided into several parts:
1. Proximal convoluted tubule (PCT)
2. Loop of Henle: descending limb, thin ascending limb and
thick ascending limb
3. Distal convoluted tubule (DCT): the portion of DCT near
juxtagolmerular cells contains special area called macula
densa.
macula densa cells are sensitive to the concentration of
sodium chloride in the DCT
The juxtaglomerular cells and macula densa of DCT is formed
the juxtaglomerular apparatus.
Functions of the kidneys
1. Urine formation
The composition of urine reflect exchange of substances between the
nephron and the blood in the renal capillaries.
Waste products of protein metabolism are excreted, electrolyte levels are
controlled and pH (acid base balance) is maintained by excretion of
H ions.
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to produce urine, there are three basic processes:
Glomerular filtration
Tubular reabsorption
Tubular secretion
Urine excretion
Urine Formation
Glomerular filtration
• Glomerular filtration occurs in the semipermeable walls of the glomerulus and
glomerular capsule.
• Water and other small molecules (salts, ions, glucose, amino acids, creatinin,
urea, and others) pass through these walls, while blood cells, plasma proteins and
other large molecules are too large to filtrate.
• Filtration takes place because there is difference between blood pressure in the
glomerulus and the pressure of the filtrate in the glomerular space (urinary
space).
• Three pressures in the renal corpuscle control the filtration process these are:
Blood hydrostatic pressure = 55 mmHg
Blood osmotic pressure = 30 mmHg
Capsular (filtrate) hydrostatic pressure = 15 mmHg
• The net filtration pressure (NFP) is:
NFP = BHP – ( BOP + FHP) = 55- (30 + 15) = 10 mmHg
• The volume of filtrate formed by kidneys each minute is called Glomerular
Filtration Rate (GFR).
• Normally GFR = 125 ml/ minute i.e. 180 liters/ day of filtrate by two
kidneys.
• Factors influencing GFR:
1. Hydrostatic pressure
2. Osmotic pressure gradient
3. Permeability of capillaries
GFR is increased during pregnancy as metabolites produced in the fetus have
also to be excreted.
GFR is decreased in hypotension and in advanced renal diseases.
• Nearly all the filtrate is later reabsorbed and only less 1% i.e. 1.5 liters
excreted as urine.
Tubular Reabsorption and Tubular Secretion
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Tubular reabsorption: means selectively moving substances like nutrients, electrolytes and
others from filtrate (nephron tubule) back into blood. This process is important for
maintenance the consistency of internal environment of the body.
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Tubular secretion: means selectively moving substances from blood to the filtrate (nephron
tubule).
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in the proximal convoluted tubule:
reabsorption: K ion, H2O (65%), NaCl (65%), HCO3 ions, amino acids (100%), glucose
secretion:
Uric acid, organic acids.
(100%).
The majority of reabsorption occurs in PCT
• In the Loop of Henli:
reabsorption: H2O (descending part of Henli) and NaCl 25% (ascending part of Henli)
• In the distal convoluted tubule (DCT):
reabsorption : NaCl (5%), H2O
Secretion : K ion, H ion.
the majority of secretions occurs in DCT.
• Collecting tubules:
reabsorption: small amaunts of Urea, and NaCl (5%), and H2O.
Composition of urine
• Urine is clear and amber in color (due to presence of urobilin).
The pH is around 6 (normal range of 4.5 – 8).
• Urine production is decreased during sleeping and exercise.
• The components of urine are:
Water 96%
Urea 2%
(Uric acid, Creatinine , Ammonia , Sodium , Potassium,
Chlorides , Phosphates , Sulphates, Oxalates) 2%.
Hormones that Influence Selective Reabsorption
1.
Parathyroid hormone and Calcitonin:
these hormones regulate the
reabsorption of calicium and phoshate from distal collecting tubules.
2.
Antidiuretic Hormone (ADH):
• secreted by posterior lobe of pituitary gland.
• acts on distal convoluted tubules and collecting tubules that leads to increase the
reabsporption of water.
• secretions of ADH is controlled by a negative feed back mechanism.
3.
Aldosterone:
• Secreted by adrenal cortex
• Increases the reabsorption of sodium and water and the excretion of potassium.
• Secretion is regulated through negative feed back mechanism.
4.
Atrial natriuretic peptide (ANP)
• Secreted by the atria of the heart in response to increase blood volume.
• Acts to decrease reabsorption of sodium and water from the proximal convoluted
tubules and collecting tubules.
• Secretion of ANP is also regulated by negative feedback mechanism.
2. Maintenance of
Water Balance :
Decrease water in the
body leads to:
1. increase blood osmolarity
over 300 mOsm/ L.
2. osmotoreceptor in the
hypothalamus are sensitive
to changes in the blood
osmolarity so two things
occur: feeling thirst and
secretion of ADH.
3. ADH enhances water
reabsorption by renal
tubules.
Therefore the volume of
urine becomes decrease
When blood volume is
increased stretch receptors in
the atria of the heart release
atrial natriuretic hormone
(ANP).
ANP reduces reabsorption of
sodium and water by the
proximal convoluted tubules
and collecting ducts (i.e.
more sodium and water are
excreted).
3. Control of Blood Pressure
• Macula densa cells of juxtaglomerular apparatus are very sensitive to decrease in
sodium and in decrease in blood pressure.
• When blood pressure is low the cells of macula densa send stimulus to the
juxtaglomerular cells to secret renin.
• Renin acts on protein (synthesized by the liver) is called angiotensinogen.
• Renin converts angiotensinogen to the angiotensin I, then angiotensin I converted
to angiotensin II by enzyme called angiotensin converted enzyme (produced by
lungs).
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angiotensin II acts by two ways to raised blood pressure
1. directly on the blood vessels and leads to vasoconstriction.
2. enhances adrenal cortex to release aldosterone hormone.
• Aldosterone acts on renal tubules to increase reabsorption of sodium and water.
Renin- Angiotensin- Aldosterone System
4. Acid - Base Balance
• Under normal conditions the pH of urine is acidic.
• The kidneys regulate the blood pH by three main mechanisms:
1.
Reabsorption of the filtered HCO3 ions.
2.
Generation of NaHCO3 ions
3.
Excretion of acid as H ions as titrable acid and as NH4 ammonium.
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The kidneys regulate blood pH by increasing or decreasing the excretion of
hydrogen and bicarbonate as required. If the pH falls hydrogen ion excretion
is increased and bicarbonate conserved.
5. other mains functions of the kidneys is secreted
hormones and activated vitamin D3.
Urine transportation, Storage and
Elimination
• Urine drains through papillary ducts into the minor calyces,
which join to become major calyces that unite to form the
renal pelvis.
• From the renal pelvis urine first drains into the ureters and then
into urinary bladder.
• Then urine is discharged from the body through the single
urethra.
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Ureters
The ureters (right and left) are long tubes which convey the urine from the renal pelvis to
urinary bladder.
Each ureter is about 25 -30 cm long and about 4-5 mm in diameter.
Parts of ureter:
₋ abdominal part extends from the renal pelvis to the brim of
bony pelvis
₋ pelvis part at the brim of pelvis the ureter crosses the upper end of the
external iliac artery and vein and comes to the lie on the lateral wall of the pelvis than runs
forwards to reach the urinary bladder.
₋ intracystic part is the small of the ureter which passes obliquely through
the posterior wall of urinary bladder.
There are no anatomical valve at the opening of each ureter into the the urinary bladder.
obliquely passage of the intracystic part of ureter leads to form a physiological valve which
closes the ureter opening when the bladder filled with urine and prevents the backflow of
urine.
Ureter wall consists of three coats:
outer fibrous coat
middle muscular coat
inner mucous coat
Peristaltic contractions of the muscular layer of the ureter lead to urine transportation to the
bladder.
The Ureters
Urinary Bladder
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The urinary bladder is a reservoir for urine, it lies in the pelvic cavity in front of rectum
in male and uterus in female. Its size and position vary, depending of the volume of the
urine it contains, when distended the bladder rises into the abdominal cavity.
The peritoneum covers only the superior surface of the bladder.
The bladder is roughly bear shaped but becomes more oval as it fills with urine.
Inner surface of the bladder is arranged in folds when the bladder is empty and
gradually disappear as it fills.
The total capacity of the bladder is about 600 ml
The bladder opens into the urethra at its lowest point (the neck).
The three orifice in the bladder wall form a triangle or trigone. The upper two orifices
on the posterior wall ore the opening of the ureters and the lower orifice is the opening
in to the urethra.
The bladder wall is composed three layers:
1. the outer layer of loose connective tissue containing blood and lymphatic vessels and
nerves.
2. the middle layer is formed by smooth muscle fibers which are arranged in the three
layers , the fiber of external internal fibers are arranged longitudinally while the middle
fibers arranged circularly. Contraction of this muscle caot is responsible for empty of the
bladder.
3. mucosa (transitional mucous membrane).
Urethra and its Sphincters
• The tube that connect the lower end (neck) of the bladder to the exterior.
• Male urethra is about 20 cm in length, is divided into 3 parts: prostatic urethra
(3 cm), membranous urethra (1.25 cm), and penile urethra (15.75 cm).
Membranous urethra is surrounded by external sphincter.
• The male urethra is associated with the urinary and the reproductive system
• Female urethra is about 3.8 cm long. It extends from the neck of the bladder to
the external meatus. It transverses the external sphincter and lies immediately
in front of the vagina.
• Internal sphincter of the urethra : it is formed from thickening in the circular
smooth muscle in the area of the neck of the bladder.
• External sphincter of the urethra: it is formed from skeletal muscle fibers
(voluntary). This sphincter provides voluntary control over micturition.
Urethra and its Sphincters
Micturition
• when 300 -400 ml of urine have accumulated in the bladder, sensory nerve
fibers in the bladder wall sensitive to stretch are stimulated.
• In the infant this initiates spinal reflex and micturation occurs, urine passed
in the response to the parasympathetic stimulation of the bladder causing
contraction of the detrusor muscle and relaxation of the internal sphincter,
urine is expelled from the bladder and passes through the urethra before
leaving the body.
• When the nervous system is fully developed the micturition reflex is
stimulated but sensory impulses also pass upwards to the brain and there is
awarness of the need to pass urine. By learned and conscious effect
contraction of the external urethral sphincter and muscles of the pelvic
floor can inhibit micturition until it is convenient to empty the bladder.
When detrusor muscle contract and there is reflex relaxation of the internal
sphincter and voluntary relaxation of the external sphincter.